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TABLE 3 Questionnaire Section Topics and Responses TABLE 4 Questionnaire Section Topics and Responses
Questionnaire Section Topics* Questionnaire Section Topics*
Section 1: Current situation of the terrorist threat in western Section 5: Preventive and operational performance strategy
countries Question Answer
Questions Answers How much do you agree with this section, after 98%
Do you consider the epidemiological data presented Yes: 88.9% recommendations?
in the document suits the healthcare reality? No: 11.1% Section 6: Responder stratification by interaction level in the
How much do you agree with this section? 83.7% civil tactical chain of survival
Section 2: Relevant points in intentional mass casualty incidents Question Answer
Question Answer How much you do agree with this section, after 98.1%
How much do you agree with this section? 85.5% recommendations?
Section 3: Response to improve survival in terrorist incidents: *Agreement = Likert >7.
The Hartford Consensus as an international reference.
Question Answer military reality. Although the main sources of information
How much do you agree with this section? 90.9% have their origin in the theater of operations, the empirical
Section 4: Principles of the Victoria I Consensus base of civil origin must be considered to develop response
Question Answer models according to the local situation.
How much do you agree with this section? 94.5%
Section 5: Preventive and operational performance strategy Conclusion
Question Answer The most critical aspect to offer the most effective medical in-
How much do you agree with this section? 74.6% terventions in IMCIs must be the possibilities of timely execu-
Main point of disagreement (summary): tion of the response model agreed upon by the local response
• The proposed model does not adapt to all the areas of Spain. system. The EMAET approach is especially useful in areas
A general IMCI model should be created and each autonomous
region should have the freedom to adapt it. with short response times because it allows greater integra-
Specific recommendations made before the second round: tion with the assault team and indisputably optimizes security
• Each region should adapt its local response model according during medical assistance. However, in more sparsely popu-
to its own experience. lated areas, the EMAET approach may not be feasible, mainly
Section 6: Responder stratification by interaction level in the because of the longer response times and local capacities. The
civil tactical chain of survival choice of a realistic medical response model in indirect threat
Questions Answers environments should be left to the discretion of each emer-
Do you think the proposed actions are coherent with Yes: 83.6% gency response agency, under police coordination and protec-
the healthcare staff competencies? No: 16.4% tion. Alternatives to the EMAET model allow time to be saved
Do you think the proposed model is applicable in the Yes: 60% in those areas where there is no better response, but it involves
region where you currently work? No: 40% a higher risk because the assault team will not integrate a spe-
Yes: 96.4% cialized team of tactical medics.
Do you consider hospitals a potential terrorist target?
No: 3.6%
How much do you agree with this section? 74.6% Acknowledgments
Main point of disagreement (summary): We acknowledge useful discussions with the panel of experts
• The proposed response model will depend on each regional who participated in the survey, and Juan José Giménez Media-
EMS and the existing roles in the area. First healthcare villa and his team of SAMUR Madrid-PC, for their support.
responders won’t usually be TEMS specialists (EMAET).
Specific recommendations made before second round: References
• In the absence of EMAET specialists, traditional EMS staff 1. The Advanced Law Enforcement Rapid Response Training
and the Police on scene must coordinate and agree on the best (ALERRT) Center at Texas State University and the Federal
response strategy prioritizing security. Bureau of Investigation. Active Shooter Incidents in the United
• It would be interesting to include recommendations for those
areas where specialized teams will have a delayed response. States in 2016 and 2017. https://www.fbi.gov/file-repository
/active-shooter-incidents-us-2016-2017.pdf/view. Washington, D.C.:
Section 7: Conclusions U.S. Department of Justice; April 2018. Accessed February 2020.
Question Answer 2. Department of Homeland Security. Strategic Framework for Coun-
How much do you agree with this section? 89% tering Terrorism and Targeted Violence. https://www.hsdl.org
Section 8: Bibliography /?view&did=829572. September 2019. Accessed February 2020.
3. The Advanced Law Enforcement Rapid Response Training
Question Answer (ALERRT) Center at Texas State University and the Federal
How much do you agree with this section? 96.3% Bureau of Investigation. Active Shooter Incidents in the United
*Agreement = Likert >7. States in 2018. https://www.fbi.gov/file-repository/active-shooter
EMAET = tactical environment medical support teams; EMS = emer- -incidents-in-the-us-2018-041019.pdf. Washington, D.C.: U.S. De-
gency medical support; IMCI = intentional mass casualty incident; partment of Justice; April 2019. Accessed February 2020.
TEMS = Tactical Emergency Medical Support. 4. Gun Violence Archive. Gun Violence Archive 2020. https://www
.gunviolencearchive.org. Washington, D.C.: Gun Violence Ar-
chive; 2020. Accessed February 2020.
model is not possible, the RTF model can offer improvements 5. National Consortium for the Study of Terrorism and Responses
over ordinary medical response in IMCIs. to Terrorism (START). Global Terrorism Database (GTD).
https://www.start.umd.edu/research-projects/global-terrorism
-database-gtd. University of Maryland, College Park, MD: Na-
The results of the expert panel must be understood in a civil tional Consortium for the Study of Terrorism and Responses to
context because the analyzed approaches may differ from the Terrorism; 2020. Accessed February 2020.

98 | JSOM Volume 20, Edition 4 / Winter 2020